arterial clínica y con MAPA
7.10 Aportaciones del estudio
1. Demostramos dentro del ámbito de Atención Primaria como las mediciones clínicas comparadas con las medidas con MAPA tienen una concordancia baja. 2. Aporta además datos de la validez y la seguridad (sensibilidad, especificidad y
valores predictivos) de la medida clínica en comparación con la medida “Gold Estándar” mediante MAPA.
3. Este estudio confirma que la MAPA permite mejorar la práctica clínica. 4. Aporta datos de la alta comorbilidad de los pacientes con HTA. 5. Muestra el riesgo cardiovascular de los pacientes hipertensos.
Discusión
141 6. Identifica las variables asociadas que pueden modificar la concordancia de las
Conclusiones
143
Conclusiones
Conclusiones
Conclusiones
145
8
Conclusiones
1. Existe una alta prevalencia de comorbilidad en los pacientes hipertensos.
2. El riesgo cardiovascular medio de los pacientes es moderado según las escalas SCORE, DORICA y Framingham.
3. Más de la mitad de los pacientes hipertensos según las mediciones clínicas en la consulta, están mal controlados. Dicho porcentaje de mal control se reduce con la MAPA del periodo de 24 horas y aún más con la MAPA del período diurno.
4. La media de las mediciones clínicas presenta valores más elevados que la realizada con MAPA en todos los períodos considerados y las diferencias son estadísticamente significativas. Las diferencias son mayores para la presión arterial sistólica que la presión arterial diastólica en todos los periodos del registro de MAPA.
5. La concordancia observada entre las medidas clínica y mediante MAPA (en cualquiera de sus periodos: de 24 h, diurno o nocturno) para la clasificación de presión arterial mal controlada o hipertensión establecida es baja.
6. Existe una alta prevalencia de falsos positivos (“efecto bata blanca o hipertensión clínica aislada”) cuando utilizamos como valor estándar la MAPA de 24 horas y dicha prevalencia aún es mayor cuando utilizamos como valor estándar la MAPA diurno. Existe a su vez una discreta prevalencia de falsos negativos (“hipertensión enmascarada”) según se utilice como referencia la MAPA de 24 horas o la MAPA del período diurno
7. La sensibilidad, especificidad y valores predictivos del diagnóstico clínico para el control de la presión arterial en comparación con la MAPA, no son suficientemente altos.
8. La única variable, en el límite de la significación estadística, que influye en la predicción de discordancia entre la presión arterial clínica y mediante MAPA de 24 h, es el índice de masa corporal tras ajustar por las variables: edad, sexo, índice de masa corporal, comorbilidad de Charlson y estimación del filtrado glomerular. A mayor índice de masa corporal, mayor probabilidad de discordancia. En la MAPA del periodo diurno la variable asociada a la discordancia en el límite de la significación estadística es la comorbilidad.
Conclusiones
146 9. Casi la mitad de los pacientes no tienen descenso adecuado (Patrón Dipper) de la presión arterial durante el periodo nocturno. La presencia del patrón Dipper o no, no modifica la discordancia entre la medición clínica y la MAPA de los períodos de 24 horas y diurno.
10.Este estudio confirma que la utilización de la MAPA permite mejorar la práctica clínica.
Bibliografía
147
9
Bibliografía
1. Lyons A. Medicine, an illustrated history. Abrams Publishers, New York, 1978; 477-593.
2. Riva-Rocci S. Un nuevo esfingomanómetro. Gazzeta Medica di Torino. 1986;1950:981-96.
3. Korotkoff NS. On Methods of studying blood pressure (in Russian). Bull Imperial Mil Med Avad. 1905;11:365-7.
4. Rose G. Standardisation of observers in blood pressure measurement. Lancet. 1965; 10:673-4.
5. Velasco AR, García M, Fernández I, Tuero R, López V, Herrera J. Estado de calibración de los esfigmomanómetros en los centros de salud de Oviedo. Hipertensión. 1997; 14:267-270.
6. Mayoral E, Iglesias P, Cayuela A, Iborra M, Lapetra J, Santos JM. La medida de la presión arterial: ¿es cosa de médicos? Aten Primaria. 1999;24(Supl 2):248.
7. Pickering TG, Miller NH, Ogedegbe G, Krakoff LR, Artinian NT, Goff D, et al. Call to action on use and reimbursement for home blood pressure monitoring: executive summary: a joint scientific statement from the American Heart Association, American Society Of Hypertension, and Preventive Cardiovascular Nurses Association. Hypertension. 2008;52(1):1-9.
8. Hinman AT, Engel BT, Bickford AF. Portable blood pressure recorder. Accuracy and preliminary use in evaluating intradaily variations in pressure. Am Heart J. 1962 May;63:663-8.
9. Sokolow M, Werdegar D, Kain HK, Hinman AT. Relationship between level of blood pressure measured casually and by portable recorders and severity of complications in essential hypertension. Circulation. 1966 Aug;34(2):279-98.
10. Perloff D, Sokolow M, Cowan R. The prognostic value of ambulatory blood pressures. JAMA. 1983 May 27;249(20):2792-8.
11. Staessen JA, Thijs L, Fagard R, O'Brien ET, Clement D, de Leeuw PW, et al. Predicting cardiovascular risk using conventional vs ambulatory blood pressure in older patients with systolic hypertension. Systolic Hypertension in Europe Trial Investigators. JAMA. 1999 Aug 11;282(6):539-46.
Bibliografía
148 12. Clement DL, De Buyzere ML, De Bacquer DA, de Leeuw PW, Duprez DA, Fagard RH, et al. Prognostic value of ambulatory blood-pressure recordings in patients with treated hypertension. N Engl J Med. 2003 Jun 12;348(24):2407-15.
13. Hansen TW, Jeppesen J, Rasmussen S, Ibsen H, Torp-Pedersen C. Ambulatory blood pressure monitoring and risk of cardiovascular disease: a population based study. Am J Hypertens. 2006 Mar;19(3):243-50.
14. Hypertension. The clinical management of primary hypertension in adults Clinical Guideline. National Clinical Guideline Centre – August 2011. [Internet]. [Acceso 2 de marzo de 2012]. Disponible en: www.nice.org.uk/guidance/CG127
15. Rabi DM, Daskalopoulou SS, Padwal RS, Khan NA, Grover SA, Hackam DG, et al. The 2011 Canadian Hypertension Education Program recommendations for the management of hypertension: blood pressure measurement, diagnosis, assessment of risk, and therapy. Can J Cardiol. 2011 Jul-Aug;27(4):415-433.
16. Kaplan NM. Ambulatory blood pressure monitoring and white coat hypertension in adults. [Internet]. UpToDate; 2011 [Acceso 30 de enero de 2012]. Disponible en: http://www.uptodate.com/store.
17. Canter DA, Texter MJ, McLain RW. Short report: ambulatory blood pressure monitoring can play an integral role in patient selection, dosage adjustment and efficacy assessment in clinical trials of antihypertensive agents. J Hypertens. 1994 Apr;12(4):491-4.
18. Omboni S, Parati G, Mancia G. The trough: peak ratio and the smoothness index in the evaluation of control of 24 h blood pressure by treatment in hypertension. Blood Press Monit. 1998 Jun;3(3):201-4.
19. Dolan E, Stanton A, Thijs L, Hinedi K, Atkins N, McClory S et al. Superiority of ambulatory over clinic blood pressure measurement in predicting mortality: the Dublin outcome study. Hypertension. 2005;46(1):156-61.
20. Clement DL, De Buyzere ML, De Bacquer DA, de Leeuw PW, Duprez DA, Fagard RH, et al. Prognostic value of ambulatory blood-pressure recordings in patients with treated hypertension. N Engl J Med. 2003;348(24):2407-15.
21. Agarwal R, Andersen MJ. Prognostic importance of ambulatory blood pressure recordings in patients with chronic kidney disease. Kidney Int. 2006;69(7):1175-80. 22. Zachariah PK, Sheps SG, Bailey KR, Wiltgen CM, Moore AG. Age-related characteristics of ambulatory blood pressure load and mean blood pressure in normotensive subjects. JAMA. 1991;265(11):1414-7.
23. White WB, Dey HM, Schulman P. Assessment of the daily blood pressure load as a determinant of cardiac function in patients with mild-to-moderate hypertension. Am Heart J. 1989;118(4):782-95.
Bibliografía
149 24. Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr, et al. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA. 2003;289(19):2560-72.
25. Watson RD, Lumb R, Young MA, Stallard TJ, Davies P, Littler WA. Variation in cuff blood pressure in untr eated outpatients with mild hypertension--implications for initiating antihypertensive treatment. J Hypertens. 1987;5(2):207-11.
26. Pickering TG, James GD, Boddie C, Harshfield GA, Blank S, Laragh JH. How common is white coat hypertension? JAMA. 1988;259(2):225-8.
27. Pierdomenico SD, Cuccurullo F. Prognostic value of white-coat and masked hypertension diagnosed by ambulatory monitoring in initially untreated subjects: an updated meta analysis. Am J Hypertens. 2011;24(1):52-8.
28. Muxfeldt ES, Bloch KV, Nogueira Ada R, Salles GF. True resistant hypertension: is it possible to be recognized in the office? Am J Hypertens. 2005;18(12 Pt 1):1534-1540.
29. Verdecchia P, Palatini P, Schillaci G, Mormino P, Porcellati C, Pessina AC. Independent predictors of isolated clinic ('white-coat') hypertension. J Hypertens. 2001;19(6):1015-1020.
30. Parati G, Valentín M. Prognostic relevance of blood pressure variability. Hypertension. 2006; 47:137-8.
31. Verdecchia P, Reboldi GP, Angeli F, Schillaci G, Schwartz JE, Pickering TG, et al. Short- and long-term incidence of stroke in white-coat hypertension. Hypertension. 2005;45(2):203-8.
32. Palatini P, Mormino P, Santonastaso M, Mos L, Dal Follo M, Zanata G, et al. Target-organ damage in stage I hypertensive subjects with white coat and sustained hypertension: results from the HARVEST study. Hypertension. 1998;31(1):57-63. 33. Bidlingmeyer I, Burnier M, Bidlingmeyer M, Waeber B, Brunner HR. Isolated office hypertension: a prehypertensive state?. J Hypertens. 1996;14(3):327-32.
34. O'Brien E, Asmar R, Beilin L, Imai Y, Mancia G, Mengden T, et al; European Society of Hypertension Working Group on Blood Pressure Monitoring. Practice guidelines of the European Society of Hypertension for clinic, ambulatory and self blood pressure measurement. J Hypertens. 2005 Apr;23(4):697-701.
35. Niiranen TJ, Hänninen MR, Johansson J, Reunanen A, Jula AM. Home- measured blood pressure is a stronger predictor of cardiovascular risk than office blood pressure: the Finn-Home study. Hypertension. 2010;55(6):1346-51.
Bibliografía
150 36. Agarwal R, Bills JE, Hecht TJ, Light RP. Role of home blood pressure monitoring in overcoming therapeutic inertia and improving hypertension control: a systematic review and meta-analysis. Hypertension. 2011;57(1):29-38.
37. Mancia G, De Backer G, Dominiczak A, Cifkova R, Fagard R, Germano G, et al. 2007 Guidelines for the management of arterial hypertension: The task force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens. 2007; 25:1105–87. 38. Sociedad Española de Hipertensión-Liga Española para la lucha contra la Hipertensión Arterial (SEH-LELHA). Guía de diagnóstico y tratamiento de la hipertensión arterial en España 2005. Hipertensión. 2005; 22 Suppl 2:1-84.
39. Vinyoles Bargalló E, de la Figuera von Wichmann M. Reproductibilidad de la clasificación dipper/non dipper en el paciente hipertenso. Hipertensión. 2002;19(3):108- 13.
40. Coca A, Bertomeu V, Dalfó A, Esmatjes E, Guillén F, Guerrero L, et al. Automedida de la presión arterial. Documento de Consenso Español 2007. Hipertensión. 2007;24(2):70-83.
41. Pickering TG. The influence of daily activity on ambulatory blood pressure. Am Heart J. 1988;116(4):1141-5.
42. Beevers G, Lip GY, O'Brien E. ABC of hypertension. Blood pressure measurement. Part I-Sphygmomanometry: factors common to all techniques. BMJ. 2001 Apr 21;322(7292):981-5.
43. Littler WA, Honour AJ, Carter RD, Sleight P. Sleep and blood pressure. Br Med J. 1975; 3: 346-348.
44. O'Brien E, Atkins N, O'Malley K. Defining normal ambulatory blood pressure. Am J Hypertens. 1993; 6 (6 Pt 2): 201S-206S.
45. Di Rienzo M, Grassi G, Pedotti A, Mancia G. Relationship of 24-hour average blood pressure. Hypertension. 1983; 5:264-69.
46. Pickering T. Diurnal rhythms and other sources of blood pressure variability in normal and hypertensive subjects. En: Hypertension: Pathophysiology, Diagnosis and Management. Cap 86: 1397-1403. Ed. Laragh and Brenner. Raven Press, Ltd. New York 1990.
47. Zweiker R, Eber B, Schumacer M. Nondipping related to cardiovascular events in essential hypertensive patients. Acta Med Aust. 1994;21:86-9.
48. Fan HQ, Li Y, Thijs L, Hansen TW, Boggia J, Kikuya M, et al. Prognostic value of isolated nocturnal hypertension on ambulatory measurement in 8711 individuals from 10 populations. J Hypertens. 2010;28(10):2036-45.
Bibliografía
151 49. Birkenhäger AM, van den Meiracker AH. Causes and consequences of a non- dipping blood pressure profile. Neth J Med. 2007; 65(4): 127-31.
50. Kario K, Pickering TG, Umeda Y, Hoshide S, Hoshide Y, Morinari M, et al. Morning surge in blood pressure as a predictor of silent and clinical cerebrovascular disease in elderly hypertensives: a prospective study. Circulation. 2003;107(10):1401-6. 51. Metoki H, Ohkubo T, Kikuya M, Asayama K, Obara T, Hashimoto J, et al. Prognostic significance for stroke of a morning pressor surge and a nocturnal blood pressure decline: the Ohasama study. Hypertension. 2006;47(2):149-54.
52. Cuspidi C, Meani S, Salerno M, Valerio C, Fusi V, Severgnini B, et al. Reproducibility of nocturnal blood pressure fall in early phases of untreated essential hypertension: a prospective observational study. Journal of Human Hypertension. 2004; 18(7): 503-9.
53. Mancia G, Zanchetti A, Agabiti-Rosei E, Benemio G, De Cesaris R, Fogari R, et al. Ambulatory blood pressure is superior to clinic blood pressure in predicting treatment-induced regression of left left ventricular hypertrophy. SAMPLE Study Group. Study on Ambulatory Monitoring of Blood Pressure and Lisinopril Evaluation. Circulation. 1997 Mar 18;95(6):1464-70.
54. Omboni S, Parati G, Palatini P, Vanasia A, Muiesan ML, Cuspidi C, et al. Reproducibility and clinical value of nocturnal hypotension: prospective evidence from the SAMPLE study. Study on Ambulatory Monitoring of Pressure and Lisinopril Evaluation. J Hypertens. 1998 Jun;16(6):733-8.
55. Cowley AW, Liard JF, Guyton AC. Role of the baroreceptor reflex in daily control of arterial blood pressure and other variables in dogs. Circ Res. 1973; 32: 564- 576.
56. Mancia G, Ferrari A, Gregorini L, Parati G, Pomidossi G, Bertinieri G, et al. Blood pressure variability in man: its relation to high blood pressure, age and baroreflex sensitivity. Clin Sci. 1980; 59 Supl 6: 401s-404s.
57. Hesse C, Charkoudian N, Liu Z, Joyner MJ, Eisenach JH. Baroreflex Sensitivity Inversely Correlates With Ambulatory Blood Pressure in Healthy Normotensive Humans. Hypertension. 2007;50 (1): 41-6.
58. Elghozi JL. Short-term variability of blood pressure: physiology and pharmacology. Ann Pharm Fr. 2008;66(3):158-68.
59. Julien C. The enigma of Mayer waves: Facts and models. Cardiovasc Res. 2006; 70(1):12-21.
60. Peixoto AJ, White WB. Circadian blood pressure: clinical implications based on the pathophysiology of its variability. Kidney Int. 2007 May;71(9):855-60.
Bibliografía
152 61. Willich SN, Goldberg RJ, Maclure M, et al. Increased onset of sudden cardiac death in the first three hours of awakening. Am J Cardiol. 1992; 70: 65-68.
62. Kario K, Pickering TG, Hoshide S, Eguchi K, Ishikawa J, Morinari M, et al. Morning blood pressure surge and hypertensive cerebro vascular disease: role of the alpha adrenergic sympathetic nervous system. Am J Hypertens. 2004; 17(8):668-75. 63. Cohen MC, Rohtla KM, Lavery CE, Muller JE, Mittleman MA. Meta-analysis of the morning excess of acute myocardial infarction and sudden cardiac death. Am J Cardiol. 1997 Jun 1;79(11):1512-6.
64. Elliott WJ. Circadian variation in the timing of stroke onset: a meta-analysis. Stroke. 1998; 29: 992–6.
65. Clement Di, De Pue N, Jordaens IJ, Packet L. Adrenergic and vagal influences on blood pressure variability. Clin Exp Hypertens A. 1985; 7 (2-3): 159-166.
66. Portaluppi F, Bagni B, degli Uberti E, Montanari L, Cavallini R, Trasforini G, et al. Circadian rhythms of atrial natriuretic peptide, renin, aldosterone, cortisol, blood pressure and heart rate in normal and hypertensive subjects. J Hypertens. 1990 Jan;8(1):85-95.
67. Qiu YG, Yao XY, Tao QM, Zheng P, Chen JZ, Zhu JH, Zhang FR, Zheng LR, Zhao LL. [Profile on circadian blood pressure and the influencing factors in essential hypertensive patients after treatment]. Zhonghua Liu Xing Bing Xue Za Zhi. 2004 Aug;25(8):710-4.
68. Grassi G. Role of the sympathetic nervous system in human hypertension. J Hypertens. 1998; 16:1979-87
69. Reeves RA. Does this patient have hipertensión? JAMA. 1995; 273:1211-8. 70. Mansoor GA, White WB, McCabe EJ, Giacco S. The relationship of electronically monitored physical activity to blood pressure, heart rate, and the circadian blood pressure profile. Am J Hypertens. 2000; 13: 262–7.
71. Lusardi P, Zoppi A, Preti P, Pesce RM, Piazza E, Fogari R. Effects of insufficient sleep on blood pressure in hypertensive patients: a 24-h study. Am J Hypertens. 1999;12(1 Pt 1):63-8.
72. Osanai T, Okuguchi T, Kamada T, Fujiwara N, Kosugi T, Saitoh G. Salt-induced exacerbation of morning surge in blood pressure in patients with essential hypertension. J Hum Hypertens. 2000;14(1):57-64.
73. Groppelli A, Giorgi DM, Omboni S, Parati G, Mancia G. Persistent blood pressure increase induced by heavy smoking. J Hypertens. 1992;10(5):495-9.
Bibliografía
153 74. Puddey IB, Jenner DA, Beilin LJ, Vandongen R. Alcohol consumption, age and personality characteristics as important determinants of within-subject variability in blood pressure. J Hypertens Suppl. 1988;6(4):S617-9.
75. Potter JF, Watson RD, Skan W, Beevers DG. The pressor and metabolic effects of alcohol in normotensive subjects. Hypertension. 1986;8(7):625-31.
76. Giaconi S, Ghione S, Palombo C, Genovesi-Ebert A, Marabotti C, Fommei E, et al. Seasonal influences on blood pressure in high normal to mild hypertensive range. Hypertension. 1989 Jul;14(1):22-7.
77. Woodhouse PR, Khaw KT, Pulmmer M: Seasonal variation of blood pressure and its relationship to ambient temperature in a elderly population. J Hypertens. 1993; 11: 1267-74.
78. Sega R, Cesana G, Bombelli M, Grassi G, Stella ML, Zanchetti A, Mancia G. Seasonal variations in home and ambulatory blood pressure in the PAMELA population. Pressione Arteriose Monitorate E Loro Associazioni. J Hypertens. 1998;16(11):1585-92. 79. Muntner P, Shimbo D, Tonelli M, Reynolds K, Arnett DK, Oparil S. The relationship between visit-to-visit variability in systolic blood pressure and all-cause mortality in the general population: findings from NHANES III, 1988 to 1994. Hypertension. 2011;57:160-6.
80. Pickering TG. Ambulatory monitoring and blood pressure variability. London: Science Press, 1991.
81. Verdecchia P, Borgioni C, Ciucci A, Gattobigio R, Schillaci G, Sacchi N, et al. Prognostic significance of blood pressure variability in essential hypertension. Blood Press Monit. 1996;1(1):3-11.
82. Frattola A, Parati G, Cuspidi C, Albini F, Mancia G. Prognostic value of 24-hour blood pressure variability. J Hypertens. 1993; 11: 1133-7.
83. Mulè G, Nardi E, Andronico G, Cottone S, Federico MR, Piazza G. Pulsatile and steady 24-h blood pressure components as determinants of left ventricular mass in young and middle-aged essential hypertensive. J Hum Hypertens. 2003; 17(4):231-8. 84. Birkenhäger WH, Reid JL, editores. Handbook of hypertension. En: Bulpitt CJ, editor. Vol. 6. Epidemiology of hypertension. Amsterdam: Elsevier; 1985.
85. Oparil S, Zaman MA, Calhoun DA. Pathogenesis of hypertension. Ann Intern Med. 2003;139(9):761.
86. Bühler FR, Bolli P, Kiowski W, Erne P, Hulthén UL, Block LH. Renin profiling to select antihypertensive baseline drugs. Renin inhibitors for high-renin and calcium entry blockers for low-renin patients. Am J Med. 1984;77(2A):36-42.
Bibliografía
154 87. Staessen JA, Wang J, Bianchi G, Birkenhäger WH. Essential hypertension. Lancet. 2003;361(9369):1629-41.
88. Davies AA, Smith GD, May MT, Ben-Shlomo Y. Association between birth weight and blood pressure is robust, amplifies with age, and may be underestimated. Hypertension. 2006;48(3):431-6.
89. Cooper RS, Kaufman JS. Race and hypertension: science and nescience. Hypertension. 1998;32(5):813-6.
90. Wang NY, Young JH, Meoni LA, Ford DE, Erlinger TP, Klag MJ. Blood pressure change and risk of hypertension associated with parental hypertension: the Johns Hopkins Precursors Study. Arch Intern Med. 2008;168(6):643-8.
91. Adrogué HJ, Madias NE. Sodium and potassium in the pathogenesis of hypertension. N Engl J Med. 2007;356(19):1966-78.
92. Hillbom M, Saloheimo P, Juvela S. Alcohol consumption, blood pressure, and the risk of stroke. Curr Hypertens Rep. 2011;13(3):208-13.
93. Sonne-Holm S, Sørensen TI, Jensen G, Schnohr P. Independent effects of weight change and attained body weight on prevalence of arterial hypertension in obese and non-obese men. BMJ. 1989;299(6702):767-70.
94. Carnethon MR, Evans NS, Church TS, Lewis CE, Schreiner PJ, Jacobs DR Jr, et al. Joint associations of physical activity and aerobic fitness on the development of incident hypertension: coronary artery risk development in young adults. Hypertension. 2010;56(1):49-55.
95. de Simone G, Devereux RB, Chinali M, Roman MJ, Best LG, Welty TK, et al. Risk factors for arterial hypertension in adults with initial optimal blood pressure: the Strong Heart Study. Hypertension. 2006;47(2):162-7.
96. Jalal DI, Smits G, Johnson RJ, Chonchol M. Increased fructose associates with elevated blood pressure. J Am Soc Nephrol. 2010;21(9):1543-9.
97. Forman JP, Choi H, Curhan GC. Fructose and vitamin C intake do not influence risk for developing hypertension. J Am Soc Nephrol. 2009;20(4):863-71.
98. Yan LL, Liu K, Matthews KA, Daviglus ML, Ferguson TF, Kiefe CI. Psychosocial factors and risk of hypertension: the Coronary Artery Risk Development in Young Adults (CARDIA) study. JAMA. 2003;290(16):2138-48.
99. Burgaz A, Orsini N, Larsson SC, Wolk A. Blood 25-hydroxyvitamin D concentration and hypertension: a meta-analysis. J Hypertens. 2011;29(4):636-45. 100. Bakris GL, Ritz E. The message for World Kidney Day 2009: hypertension and kidney disease: a marriage that should be prevented. Kidney Int. 2009;75(5):449-52.
Bibliografía
155 101. Woods JW. Oral contraceptives and hypertension. Hypertension. 1988;11(3 Pt 2):II11-5.
102. Hannaford PC, Iversen L, Macfarlane TV, Elliott AM, Angus V, Lee AJ. Mortality among contraceptive pill users: cohort evidence from Royal College of General Practitioners' Oral Contraception Study. BMJ. 2010;340:c927.
103. Warner TD, Mitchell JA. COX-2 selectivity alone does not define the cardiovascular risks associated with non-steroidal anti-inflammatory drugs.
Lancet. 2008;371(9608):270-3.
104. Grover SA, Coupal L, Zowall H. Treating osteoarthritis with cyclooxygenase-2- specific inhibitors: what are the benefits of avoiding blood pressure destabilization?. Hypertension. 2005;45(1):92-7.
105. White WB. Cardiovascular effects of the cyclooxygenase inhibitors. Hypertension. 2007;49(3):408-18.
106. Zanchetti A, Hansson L, Leonetti G, Rahn KH, Ruilope L, Warnold I, et al. Low- dose aspirin does not interfere with the blood pressure-lowering effects of antihypertensive therapy. J Hypertens. 2002;20(5):1015-22.
107. Baguet JP, Hammer L, Mazzuco TL, et al. Circumstances of discovery of phaeochromocytoma: a retrospective study of 41 consecutive patients. Eur J Endocrinol. 2004;150(5):681-6.
108. Safian RD, Textor SC. Renal-artery stenosis. N Engl J Med. 2001;344(6):431- 42.
109. Van de Ven PJ, Beutler JJ, Kaatee R, Beek FJ, Mali WP, Koomans HA. Angiotensin converting enzyme inhibitor-induced renal dysfunction in atherosclerotic renovascular disease. Kidney Int. 1998;53(4):986-93.
110. Aqel RA, Zoghbi GJ, Baldwin SA, Auda WS, Calhoun DA, Coffey CS, et al. Prevalence of renal artery stenosis in high-risk veterans referred to cardiac catheterization. J Hypertens. 2003;21(6):1157-62.
111. Pickering TG, Herman L, Devereux RB, Sotelo JE, James GD, Sos TA, et al. Recurrent pulmonary oedema in hypertension due to bilateral renal artery stenosis: treatment by angioplasty or surgical revascularisation. Lancet. 1988;2(8610):551-2. 112. Banegas JR, Rodríguez-Artalejo F, Ruilope LM, Graciani A, Luque M, de la Cruz-Troca JJ, et al. Hypertension magnitude and management in the elderly population of Spain. J Hypertens. 2002;20:2157-64.
113. Banegas JR, Rodríguez Artalejo F. El problema de la hipertensión arterial en España. Rev Clin Esp. 2002;202:12-5.
Bibliografía
156 114. Llisterri Caro JL, Rodríguez Roca GC, Alonso Moreno FJ, Banegas Banegas JR, González-Segura Alsina D, Lou Arnal S, et al. Grupo de Trabajo de Hipertensión